Association of comorbidities with COVID-19 infection rate and severity: nationwide cohort study with propensity score matching

OO_SCPLOWBJECTIVEC_SCPLOWTo describe the association of comorbidities with coronavirus infection-19 (COVID-19) infection rates and severity of infection through Korean nationwide medical system. DO_SCPLOWESIGNC_SCPLOWNationwide population-based retrospective cohort study. SO_SCPLOWETTINGC_SCPLOWKorean national health insurance claims database between January 1, 2020, and May 30, 2020. PO_SCPLOWARTICIPANTSC_SCPLOWPatients with positive COVID-19 test and 12 folded controls matched by age, sex and region. MO_SCPLOWAINC_SCPLOW OO_SCPLOWUTCOMESC_SCPLOW MO_SCPLOWEASURESC_SCPLOWOutcomes were confirmation of the comorbidities affecting the infection rate and the severity of COVID-19. Patients and outcomes were propensity score matching of factors which may affect COVID-19 infection rate and severity was performed. COVID-19 infections were confirmed through laboratory testing. Severe infection was defined as those who underwent tracheostomy, continuous renal replacement therapy, intensive care unit admission, ventilator use, cardiopulmonary resuscitation, or died. RO_SCPLOWESULTSC_SCPLOWA total of 8070 individuals with positive covid-19 test and 12015 controls were identified. In people aged 60 or older, in those insured with Medicaid, and in the disabled, the proportion corresponding to the severe group of patients showed a tendency to increase. The infection rate of COVID-19 was highest in pulmonary disease (adjusted odds ratio 1.88, 95% confidence interval 1.70 to 2.03), and hyperlipidemia (0.73, 0.67 to 0.80) had a lower infection rate. Disease severity was highest in kidney disease (5.59, 2.48 to 12.63), and lower in hyperlipidemia (0.78, 0.60 to 1.00). CO_SCPLOWONCLUSIONSC_SCPLOWThere is less bias as the government pays for all tests and treatments related to COVID-19 included in the data used in this study. Using propensity matching to reduce statistical bias, we found that most comorbidities increased the infection rate and severity of COVID-19, whereas hyperlipidemia reduced the rate and severity of infection. These results can be utilized to effectively manage COVID-19 infections.

Effect of Repetitive Balloon Dilatation Treatment Confirmed by High-Resolution Manometry in a Patient with Cricopharyngeal Dysfunction: A Case Report / 대한연하장애학회지

Cricopharyngeal dysfunction (CPD) has various treatment options, such as balloon dilatation (BD), botulinum toxin injection, and myotomy of the cricopharyngeal muscle. BD is less invasive, easier to implement, and economical compared to other treatments. In this study, the effectiveness and mechanism of repeating BDs in patients with CPD were verified through a videofluoroscopic swallowing study (VFSS) and high-resolution manometry (HRM). A 44-year-old male developed dysphagia after large epidural hemorrhage in the left-brain hemisphere concurrent with diffuse axonal injury. CPD was confirmed in a videofluoroscopic swallowing study, which he first performed 10weeks after a traumatic brain injury. Repetitive BDs were performed at 11, 12, 15, 18, 40, and 52 weeks after injury. Before and after the procedure, successive physiological changes were observed by HRM. The UES nadir pressure decreased from 6.4 mmHg to −2. 1 mmHg after the first procedure. The pharyngeal residue after swallowing also decreased below 50% due to relaxation of the upper esophageal sphincter (UES), and the decrease in UES pressure was maintained at 52 weeks. The patient showed improved symptoms and could eat a regular diet. This report supports repetitive videofluoroscopic guided BDs as a therapeutic option for CPD.

The Korean Dysphagia Society (KDS) Position Statement for Oropharyngeal Dysphagia / 대한연하장애학회지

Oropharyngeal dysphagia is a clinical condition caused by various underlying diseases and is characterized by difficulty in swallowing. Diagnosis and treatment of oropharyngeal dysphagia require multidisciplinary consultations. This position statement for oropharyngeal dysphagia was developed by The Korean Dysphagia Society (KDS) to outline its position on oropharyngeal dysphagia. The clinical practice guideline, position statements, a recent meta-analysis, a systematic review, and randomized controlled trials for oropharyngeal dysphagia were all performed. An expert Delphi survey was also done to achieve a consensus of opinion on this position statement. This position statement for oropharyngeal dysphagia aims to help make evidence-based decisions in clinical practice, improve clinical evaluation and manage oropharyngeal dysphagia in Korea.

Relationship Between Line Bisection Test Time and Hemispatial Neglect Prognosis in Patients With Stroke: A Prospective Pilot Study

Objective@#To determine the relationship between line bisection test (LBT) performance time and prognosis of hemispatial neglect (HSN) in stroke patients. @*Methods@#Data on stroke patients with HSN were prospectively collected. After patient recruitment and eligibility screening, the LBT, Motor-Free Visual Perception Test 3rd edition, and Korean version of Mini-Mental State Examination were performed at the time of admission and 4 weeks thereafter. The LBT performance time was also measured. All patients received conventional rehabilitation for 4 weeks. Based on the improvements in their LBT grades, the patients were divided into improved and non-improved groups. The evaluation results of the two groups were compared using Mann–Whitney U-tests and logistic regression was performed to predict the independence of each outcome. @*Results@#In total, 26 stroke patients with HSN were included, with 13 patients in each group. Significant differences were observed in the baseline LBT performance times between the improved and non-improved groups (p<0.05). Logistic regression analysis revealed associations between HSN prognosis, and baseline LBT performance time (odds ratio=0.95; 95% confidence interval, 0.90–1.00; p<0.05) and baseline Motor-Free Visual Perception Test 3rd edition (odds ratio=1.20; 95% confidence interval, 1.01–1.43; p<0.05). @*Conclusion@#A significant relationship was observed between the baseline LBT performance time and HSN prognosis.

Intensive Rehabilitation Therapy Following Brain Tumor Surgery: A Pilot Study of Effectiveness and Long-Term Satisfaction

OBJECTIVE: To evaluate the effectiveness of intensive rehabilitation to support recovery of neurological function after brain tumor surgery and assess long-term satisfaction. METHODS: This retrospective study included patients with neurological impairment after brain tumor surgery who underwent intensive rehabilitation therapy between December 2013 and May 2017. To assess effectiveness of rehabilitation, functional outcomes (motor, cognition, and activities of daily living [ADL]) were compared between brain tumor group and a control group enrolling stroke patients who received equivalent rehabilitation during the study period. Long-term satisfaction with rehabilitation was evaluated by surveying family caregivers. RESULTS: This study included 21 patients with benign brain tumor, 14 with malignant brain tumor, and 108 with stroke. Significant and similar improvement in motor, cognition, and ADL function were noted in both the brain tumor group and the stroke group. Malignancy status did not influence the extent of functional improvement. According to medical records and surveys, 9 (69.2%) patients with malignant tumor and 2 (11.8%) with benign tumor had expired by the time of the survey. Most family caregivers confirmed that rehabilitation was effective for functional improvement (>60%), expressing overall satisfaction and stating they would recommend such therapy to patients with similar conditions (approximately 70%). CONCLUSION: Intensive rehabilitation may help promote functional improvement following brain tumor surgery regardless of malignancy compared with stroke patients. Family caregivers expressed overall satisfaction with rehabilitation at long-term follow-up. These findings support the provision of intensive rehabilitation therapy for neurologic function recovery following brain tumor surgery.

Efficacy and Safety of Intra-articular Injections of Hyaluronic Acid Combined With Polydeoxyribonucleotide in the Treatment of Knee Osteoarthritis

OBJECTIVE: To assess the clinical efficacy and safety of intra-articular injection of hyaluronic acid (HA) combined with polydeoxyribonucleotide (PDRN) in patients with knee osteoarthritis in comparison with that of HA alone. METHODS: The current single-center, prospective, randomized, double-blind, controlled study was conducted in 36 patients with knee osteoarthritis at our medical institution. All the eligible patients (n=30) were equally assigned to two treatment arms (trial group ‘HA+PDRN’ and control group ‘HA’). For efficacy assessment, the patients were evaluated for the visual analogue scale (VAS) scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee Society Scores (KSS), all of which served as efficacy outcome measures. We monitored time-dependent changes in efficacy outcome measures at baseline and 1, 3 and 6 months. Subsequently, we compared differences in changes in efficacy outcome measures at 6 months from baseline between the two groups. Moreover, we assessed the safety based on the treatment-emergent adverse events (TEAEs), adverse drug reactions (ADRs) and any other complications serving as safety outcome measures. RESULTS: There were significant differences in changes in the VAS scores, the WOMAC scores in all domains, except ‘Stiffness’, the total WOMAC scores, and the KSS scores in all the domains at 6 months from baseline between the two groups (p<0.05). In our series, there were no TEAEs, ADRs, and any other complications. CONCLUSION: Intra-articular injections of HA combined with PDRN can also be considered in the treatment of knee osteoarthritis. However, further large-scale and multi-center studies are required to demonstrate the potential of the proposed combination.

Efficacy and Safety of Caregiver-Mediated Exercise in Post-stroke Rehabilitation

OBJECTIVE: To assess the efficacy and safety of our 4-week caregiver-mediated exercise (CME) in improving trunk control capacity, gait, and balance and in decreasing concerns about post-stroke falls when there is an increase in its efficacy. METHODS: Acute or subacute stroke survivors were assigned to either the trial group (n=35) or the control group (n=37). Changes in Modified Barthel Index (MBI), Functional Ambulation Categories (FAC), Berg Balance Scale (BBS), and Trunk Impairment Scale (TIS) scores at 4 weeks from baseline served as primary outcome measures. Correlations of primary outcome measures with changes in Fall Efficacy Scale-International (FES-I) scores at 4 weeks from baseline in the trial group served as secondary outcome measures. Treatment-emergent adverse events (TEAEs) served as safety outcome measures. RESULTS: There were significant differences in changes in MBI, FAC, BBS, TIS-T, TIS-D, TIS-C, and FES-I scores at 4 weeks from baseline between the two groups (all p < 0.0001). There were no significant (p=0.0755) differences in changes in TIS-S scores at 4 weeks from baseline between the two groups. MBI, FAC, BBS, and TIS scores showed significantly inverse correlations with FES-I scores in patients receiving CME. There were no TEAEs in our series. CONCLUSION: CME was effective and safe in improving the degree of independence, ambulation status, dynamic and static balance, trunk function, and concerns about post-stroke falls in stroke survivors.

Research Designs and Statistical Methods Trends in the Annals of Rehabilitation Medicine

OBJECTIVE: To investigate trends of the research designs and statistical methods in the Annals of Rehabilitation Medicine (ARM) published from 2005 to 2015 through a comparison of articles with the Archives of Physical Medicine and Rehabilitation (APMR). METHODS: The authors reviewed all articles published in ARM and APMR for the years 2005 and 2015 in order to determine their research designs as well as their statistical methods used in each article. RESULTS: In ARM, randomized controlled trials increased from 4.5% in 2005 to 6.5% in 2015. In APMR, randomized controlled trials increased from 8.1% in 2005 to 14.0% in 2015, meta-analyses increased to 5.3%, and systematic reviews increased to 6%. The number of studies using statistical methods increased in ARM from 1.9 to 2.6 per article and in APMR, from 2.7 to 3.1. Use of advanced methods in ARM also showed an increase from 2005 to 2015. CONCLUSION: This study concludes that there is a trend of increased awareness and attempts to use varied research approaches in ARM articles. There should also be more in-depth discussions and opportunities for researchers to share their experiences regarding statistical methods in the clinical field.

The Correlation Between Electrodiagnostic Results and Ultrasonographic Findings in the Severity of Carpal Tunnel Syndrome in Females

OBJECTIVE: To determine which ultrasonographic measurement can be used as an indicator reflecting the severity of carpal tunnel syndrome (CTS), by comparing electrodiagnostic results with ultrasonographic measurements in females. Many previous studies have tried to reveal that the ultrasonography (US) can possibility be used for diagnosis and severity of CTS. However, the criteria are different by gender. Thus far, there have been many efforts towards providing patients with a CTS diagnosis and severity prediction using US, but studies' results are still unclear due to lack of data on gender differences. METHODS: We collected data from 54 female patients. We classified the severity of CTS according to electrodiagnostic results. Ultrasonographic measurements included proximal and distal cross-sectional areas of the median nerve and carpal tunnel. RESULTS: The severity by electrodiagnostic results statistically correlated to the proximal cross-sectional area (CSA) of the median nerve and carpal tunnel. However, there was no relationship between the proximal and distal nerve/tunnel indexes and the severity by electrodiagnostic results. CONCLUSION: In female patients with CTS, the proximal CSAs of the median nerve and carpal tunnel increase. They correlate with the severity by electrodiagnostic findings. The CSA of the proximal median nerve could be particularly used as a predictor of the severity of CTS in female patients. However, the nerve/tunnel index is constant, irrespective of the severity of CTS.

Back Extensor Strengthening Exercise and Backpack Wearing Treatment for Camptocormia in Parkinson's Disease: A Retrospective Pilot Study

OBJECTIVE: To investigate the effect of a conservative treatment regime in Parkinson's disease patients with camptocormia. METHODS: Nine patients with Parkinson's disease were included in a retrospective pilot study of the value of back extensor strengthening exercise. Six inpatients received a 30-minute treatment, twice daily for 5 weeks, being treated on average for 34 days; while three outpatients visited the clinic and were educated for home exercise and backpack wearing treatment. Outpatients should be scheduled to visit the outpatient department to check physical status every 2–4 weeks for an average of 3 months. RESULTS: All patients except one showed statistically significant improvements in activities of daily living (ADL) and motor symptoms, as measured by flexion angle at standing posture, Unified Parkinson's Disease Rating Scale (UPDRS) II and III, and modified Hoehn-Yahr staging. CONCLUSION: Conservative treatment is effective in postural correction of camptocormia in Parkinson's disease, as well as improvement in ADL and motor symptoms.

Clinical Usefulness of Long-term Application of Fentanyl Matrix in Chronic Non-Cancer Pain: Improvement of Pain and Physical and Emotional Functions

BACKGROUND: Opioids are recently recommended for those who do not gain adequate pain relief from the use of acetaminophen or nonsteroidal anti-inflammatory drugs. Medical opioids are administered in various routes, and transdermal opioid products that can make up for the weaknesses of the oral or intravenous products have been developed. This study is to evaluate the clinical usefulness of fentanyl matrix in terms of the long-term improvement in pain and physical and mental functions. METHODS: This was a multicenter, open, prospective, observational study that was conducted in 54 institutions in Korea. Patients with non-cancerous chronic pain completed questionnaires, and investigators also completed questionnaires. A total of 1,355 subjects participated in this study, and 639 subjects completed the study. Subjects received transdermal fentanyl matrix (12 µg/hr, 25 µg/hr, or 50 µg/hr depending on the patient's response and demand). Subjects visited at 29 ± 7 days, 85 ± 14 days, and 169 ± 14 days after administration, respectively, to receive drug titration and fill out the questionnaires. The results were analyzed using the intention-to-treat (ITT) analysis, full analysis set (FAS), and per-protocol (PP) analysis. The FAS analysis included only 451 participants; the PP analysis, 160 participants; and the ITT analysis, 1,355 participants. RESULTS: The intensity of pain measured by the Numeric Rating Scale decreased from 7.07 ± 1.78 to 4.93 ± 2.42. The physical assessment score and mental assessment score of the Short-Form Health Survey 12 improved from 28.94 ± 7.23 to 35.90 ± 10.25 and from 35.80 ± 11.76 to 42.52 ± 10.58, respectively. These differences were significant, and all the other indicators also showed improvement. Adverse events with an incidence of ≥ 1% were nausea, dizziness, vomiting, and pruritus. CONCLUSIONS: The long-term administration of fentanyl matrix in patients with non-cancerous pain can reduce the intensity of pain and significantly improves activities of daily living and physical and mental capabilities.

Necessity to Develop a Tool to Evaluate Activity of Daily Living for Electric Powered Indoor/Outdoor Chair Users

OBJECTIVE: To evaluate changes in activity of daily living before and after provision of electric-powered indoor/outdoor chair (EPIOC), discuss problems of current activities of daily living (ADL) evaluating tools for EPIOC users, and provide preliminary data to develop ADL evaluation tool for EPIOC user. METHODS: A total of 70 users who were prescribed EPIOC and had been using for more than 1 year were recruited in this study. Before and after provision of EPIOC, MBI and FIM scores were measured and a questionnaire consisting of six categories (general socioeconomic states, currently using state, whether EPIOC was helpful for social participation and occupational chances, psychiatric influences, self-reported degrees of independency, and barriers of using EPIOC) was used. RESULTS: No difference in MBI scores before and after provision of EPIOC was observed. However, the wheelchair ambulation category showed a significant difference. While motor FIM was not significantly different from MBI, FIM score were significantly (p<0.05) higher than MBI. For questions regarding social participation frequency, helpfulness of EPIOC on confidence, refreshing patients' emotions and self-reported degrees of independence, all of them showed positive responses. Especially, EPIOC users' self-reported degree of independency showed favorable results. There was discrepancy in MBI or FIM measured by physicians. CONCLUSION: Our study showed that there was a gap between the existing ADL evaluation tool and the ADL level that EPIOC users were actually feeling. Thus, it is necessary to develop an evaluation tool specifically for EPIOC.

Central Hyperthermia Treated With Baclofen for Patient With Pontine Hemorrhage

Central hyperthermia is a very rare disease; however, once it happens, it is associated with a poor prognosis and high mortality for patients with severe brainstem strokes. Following a pontine hemorrhage, a 46-years-old female developed prolonged hyperthermia. Work-ups to the fever gave no significant clues for the origin of fever, and hyperthermia did not respond to any empirical antibiotics or antipyretic agents. The patient's body temperature still fluctuated in a range of 37.5degrees C to 39.2degrees C. Considering the lesion of hemorrhage, we suspected central hyperthermia rather than infectious diseases. We started with baclofen administration at a dose of 30 mg/day. The body temperature changed to a range of 36.6degrees C to 38.2degrees C. We raised the dose of baclofen to 60 mg/day. The patient's body temperature finally dropped to a normal range. Central hyperthermia, caused by failures of thermoregulatory pathways in brainstem, following the pontine hemorrhage rarely occurs. Baclofen can be used to treat suspected central hyperthermia in a patient with pontine hemorrhage.

Central Hyperthermia Treated With Baclofen for Patient With Pontine Hemorrhage

Central hyperthermia is a very rare disease; however, once it happens, it is associated with a poor prognosis and high mortality for patients with severe brainstem strokes. Following a pontine hemorrhage, a 46-years-old female developed prolonged hyperthermia. Work-ups to the fever gave no significant clues for the origin of fever, and hyperthermia did not respond to any empirical antibiotics or antipyretic agents. The patient's body temperature still fluctuated in a range of 37.5degrees C to 39.2degrees C. Considering the lesion of hemorrhage, we suspected central hyperthermia rather than infectious diseases. We started with baclofen administration at a dose of 30 mg/day. The body temperature changed to a range of 36.6degrees C to 38.2degrees C. We raised the dose of baclofen to 60 mg/day. The patient's body temperature finally dropped to a normal range. Central hyperthermia, caused by failures of thermoregulatory pathways in brainstem, following the pontine hemorrhage rarely occurs. Baclofen can be used to treat suspected central hyperthermia in a patient with pontine hemorrhage.

Analysis of Publication Status of Abstracts Presented at the Annual Meeting of the Korean Academy of Rehabilitation Medicine

OBJECTIVE: To analyze publication rate, time to publication and the characteristics of the abstracts presented at the annual Korean Academy of Rehabilitation Medicine (KARM) meetings. METHODS: A total of 1,027 abstracts presented at the 2008 and 2009 annual KARM meetings were enrolled in the database and searched for their subsequent citation in PubMed, KoreaMed, and Google Scholar. RESULTS: The data analysis revealed that 317 (30.87%) abstracts, were published as full-length journal articles and publication rates by subject were not significantly different. The mean time to publication was 17.17+/-10.48 months, and the journals written in English (20.39+/-10.20) required a longer duration than those written in Korean (11.94+/-8.44) with statistical significance (p<0.001). There was no statistical difference (p=0.284) in the duration between domestic (17.61+/-10.37) and foreign (16.48+/-10.51) of the 220 domestic journal articles, 190 (86.76%) were published in the Annals of Rehabilitation Medicine and the 97 articles published in foreign journals were scattered over 60 different journals. CONCLUSION: The publication rate of abstracts presented at the 2008 and 2009 annual KARM meetings was 30.87% and the mean time to publication was 17.17+/-10.48 months.

Therapeutic Effects and Immunomodulation of Suanbo Mineral Water Therapy in a Murine Model of Atopic Dermatitis

BACKGROUND: Balneotherapy is widely used as an alternative treatment modality for AD. Although the clinical benefit of some mineral waters has been established, their mechanisms of action in alleviating AD are only partly understood. OBJECTIVE: The clinical modification and immunomodulatory or anti-inflammatory effects of mineral water from the Suanbo hot springs on the differentiation and cytokine production of Th1, Th2, and regulatory T cells (Treg) were investigated using spleen, skin tissue, and serum from NC/Nga mice. METHODS: The therapeutic effects of bathing in mineral water in a Dermatophagoides farinae body extract ointment (Dfb ointment)-induced AD mouse model were assessed by measuring the modified Scoring atopic dermatitis (SCORAD) index scores, transepidermal water loss (TEWL), histological and immunohistochemical changes of the skin lesion, serum levels of interferon (IFN)-gamma, interleukin (IL)-4, IL-5 and immunoglobulin E, mRNA expression of IFN-gamma, IL-4 and IL-5 of dorsal skin, and helper T cell differentiation in the spleen. RESULTS: Bathing in mineral water significantly reduced the modified SCORAD index scores, TEWL, epidermal hyperplasia, and inflammatory cell infiltration. IL-4 production and Th2 cell differentiation showed a decreasing tendency with mineral water bathing, but the Th1 cells did not. On the contrary, differentiation to Treg cells was promoted with mineral water bathing. CONCLUSION: Balneotherapy not only has anti-inflammatory activity, but also shows positive effects on cutaneous barrier homeostasis. These results suggest that the favorable effects of balneotherapy may be mediated by modifying the Th2 response, and possibly in part by inducing Treg cell differentiation.

Therapeutic Effects of Mechanical Horseback Riding on Gait and Balance Ability in Stroke Patients

OBJECTIVE: To investigate the therapeutic effects of mechanical horseback riding for gait and balance parameters in post-stroke patients. METHOD: This study was a non randomized prospective positive-controlled trial over a 12 week period. From May 2011 to October 2011, 37 stroke patients were recruited from our outpatient clinic and divided into two groups. The control group received the conventional physiotherapy while the intervention group received the conventional physiotherapy along with mechanical horseback riding therapy for 12 weeks. Outcome measurements of gait included the Functional Ambulation Category (FAC) and gait part of the Performance Oriented Mobility Assessment (G-POMA) while those of balance included the Berg Balance Scale (BBS) and the balance part of the Performance Oriented Mobility Assessment (B-POMA). These measurements were taken before and after treatment. RESULTS: There were no significant differences in the baseline characteristics and initial values between the two groups. When comparing baseline and 12 weeks post treatment in each group, the intervention group showed significant improvement on BBS (39.9+/-5.7 --> 45.7+/-4.8, p=0.001) and B-POMA (10.4+/-2.6 --> 12.6+/-2.1, p=0.001), but significant improvement on gait parameters. When comparing the groups, the dynamic balance category of BBS in post treatment showed significant difference (p=0.02). CONCLUSION: This study suggests that mechanical horseback riding therapy may be an effective treatment tool for enhancing balance in adults with stroke.

Sterile Abscess Formation Associated with Two Different Forms of Gonadotropin-Releasing Hormone Agonist in Central Precocious Puberty

Long-acting formulations of gonadotropin-releasing hormone (GnRH) agonists are indicated for treating central precocious puberty. Leuprolide acetate and triptorelin acetate are widely used in Korea. Local reactions related to GnRH agonists, including erythematous macules, granulomas, subcutaneous nodules, and sterile abscesses, are the most side effects and sterile abscesses occur in less than 2-3% of treated patients. We report on two patients who had been injected with leuprolide acetate for the treatment of central precocious puberty and who subsequently presented with a sterile abscess at the injection sites. After the patients were switched to triptorelin acetate, one patient had another subcutaneous abscess at the injection site, and the other patient had no further problems. There are many theories as to the cause of these local reactions, but the mechanism has still not been elucidated. Further studies are required to identify the mechanism and the relationship between treatment effect and local reaction.

Sterile Abscess Formation Associated with Two Different Forms of Gonadotropin-Releasing Hormone Agonist in Central Precocious Puberty

Long-acting formulations of gonadotropin-releasing hormone (GnRH) agonists are indicated for treating central precocious puberty. Leuprolide acetate and triptorelin acetate are widely used in Korea. Local reactions related to GnRH agonists, including erythematous macules, granulomas, subcutaneous nodules, and sterile abscesses, are the most side effects and sterile abscesses occur in less than 2-3% of treated patients. We report on two patients who had been injected with leuprolide acetate for the treatment of central precocious puberty and who subsequently presented with a sterile abscess at the injection sites. After the patients were switched to triptorelin acetate, one patient had another subcutaneous abscess at the injection site, and the other patient had no further problems. There are many theories as to the cause of these local reactions, but the mechanism has still not been elucidated. Further studies are required to identify the mechanism and the relationship between treatment effect and local reaction.

A Survey on the Health Status of Population with Disability in Goyang City

OBJECTIVE: To improve the quality of life of the disabled population by decreasing the incidence of complications and chronic diseases and improving self-care abilities according to individual diseases through health status evaluation and basic survey. METHOD: The basic clinical information of 1,378 regional severely-disabled patients were collected along with information regarding functional level, activities of daily living, nutritional status, and management of complications which were distinguished into 3 stages (good, moderate, poor), which were correlated into scores (1-3 points) that were used to assess a collaborative score (5-15 points) that represented their health status. Health behavior and blood tests were also done. RESULTS: Health status were evaluated based on sex, grade of disability, age, frequency of exercise and type of disability, which revealed that female sex, brain disorder, 1st grade disability, total lack of exercise, old age disabled patients were relatively poor in terms of health status. CONCLUSION: Health status of the severely-disabled showed differences according to sex, age, grade of disability, type of disability, and frequency of exercise, and health programs designed to screen and follow up the severely-disabled person with poor health status as well as manage their accompanying diseases and complications are needed.